Study finds Early Start program could save US billions in health costs

December 20, 2011

A program for women at risk of substance abuse during pregnancy could save nearly $2 billion annually in health care costs if implemented nationwide, according to a Kaiser Permanente study published online in the American College of Obstetricians and Gynecologists' journal, Obstetrics & Gynecology.

The cost-benefit analysis of the Kaiser Permanente Early Start program follows a 2008 Kaiser Permanente study that showed the program helps pregnant women at risk of substance abuse achieve similar health outcomes  for both mothers and their infants  as women who do not use cigarettes, alcohol or drugs.

Kaiser Permanente has proved the program decreases maternal and neonatal morbidity and stillbirths, according to study lead author Nancy C. Goler, MD, of the Department of Obstetrics & Gynecology for The Permanente Medical Group in Vallejo, Calif.

"Now, we're able to show everyone that not only is it the right thing to do, we will save money," Dr. Goler said. "This program is a very low-technology intervention that has an enormous net cost savings."

Given the known risk of substance abuse in pregnancy Kaiser Permanente Northern California screens pregnant women by urine toxicology tests and substance-abuse screening questionnaires. This new study examined 49,261 women comparing the health care costs for pregnant women in four groups and found the Early Start program yields an average net cost benefit of $5.9 million annually.

One group of women at risk for substance abuse in pregnancy participated in full Early Start services, including a one-hour psychosocial assessment and follow-up appointments. The second group of women at risk for substance abuse had limited Early Start services, including a one-hour psychosocial assessment without follow-up. The third group of women at risk for substance abuse did not access Early Start, and the women in the control group tested negative for substance use in pregnancy and were not at risk.

Nearly $2 billion could be saved for every 4 million births each year if the program was implemented nationwide, the study estimated. The Kaiser Permanente researchers presented their cost statistics in 2009 dollars.

A large part of Early Start's success is due to the program's accessibility to patients. The program is located at the same clinic in which pregnant women receive their routine prenatal care, Dr. Goler said, adding that appointments with the woman's prenatal care provider and her Early Start specialist are coordinated. More clinicians should move their substance-abuse prevention programs for pregnant women into prenatal care sites, Dr. Goler noted.

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